Volume 1, Issue 2

 

Anti-tussive Medication use among coughing children presenting to the PED

July 28, 2010

                                                                       

Background:

 Cough medication use is a world wide phenomenon

 with sales of 3.5 billion annually in the US.

 Every week 4 million children < 12 years old use

 antitussive medication.

 There have been several recent reports of toxicity

 and death associated with their use.

 The AAP recommends against the use of antitussive

 medication in children.

 The FDA strongly recommends against the usage of

 anti-tussive medications in children below 2 years

 And even published a black box warning.

 Major recognized adverse effects include sedation,

 respiratory depression, arrhythmias, & palpitations.

 

Objectives:

The objective of this study is to determine the

 prevalence and pattern of anti-tussive medication

 use among children presenting to a Pediatric ED.

 Secondary objective is to determine factors

 associated with the use of anti-tussive medication.

 

Methods:

 Anonymous questionnaire survey (English and Spanish) given to a convenience sample of parents of children presenting to a community PED with cough as one of their symptoms.

Study conducted between September -December 2009.

Statistical analyses done using SPSS for Windows (Version 16).

 Over-the-Counter Cold and Cough Medicines Can Kill Babies, CDC Says

 Cough Medicines No Better Than Non-Medicated Placebo Syrup For Children's Coughs (July 6, 2004)

Results:      

 

Results:      

 

Total # of Survey Subjects:       n = 444

Mean age of index child            n=2.5 y

Mean parental age                    n= 25 y

Use Anti-tussive meds  n=155

 

 

 

 

 

 

 

Factors associated with anti-tussive use

Variable

Cough

Meds (155)

N               %             

No Cough Meds (309)

N             %

P value

Age of child

<2

2-5

>5

 

71                 45

48                 31

36                 23

 

157             54

72               24

60               20

 

 

0.215

Parent age

<17

17-30

>30

 

28                  18

63                 40

64                 41

 

39             13

134           46

116           40

 

 

0.337

Parent Education

>High school

 

 

43                  27

40                  13

 

 

112           72

249           86

 

 

0.001

Cough Duration

< 2  Days

> 2 Days

 

68                  43

87                  55

 

149            51

140            48

 

0.230

PCP

Has PMD

No PMD

 

128                82

27                  17

 

241           83

48             16

 

0.463

Insurance

Medicaid

Medicaid HMO

Private

Others

 

69                   44

58                   37

15                  10

13                   9

 

97             33

130           45

 65            22

34             11

 

 

0.128

Discussion:

 A previous study (Sloan Survey) found that the most

 frequently used antitussives were decongestants 

 (6.3%), first-generation antihistamines (6.3%),

 dextromethorphan(4.1%) and expectorants (1.5%).

 In contrast, dextromethorphan (13%) use was much

 higher in our survey, although decongestants (17%)

 and antihistamines (13%) were commonly used

 medications.

 Our survey found a significant association of

 antitussive use with low parental education

 conflicting with previous reports by Kogan et al who

 reported association with high parental education

 

Conclusions

 ►The prevalence rate for use of antitussive medication in this survey was 34%.

►There was no association between age, gender, parental age, type of insurance, having a PCP and antitussive use.

►Anti-tussive use was significantly associated with low parental education.

►Most common medication used was Tylenol cold followed by Robitussin and Dimetapp DM.

►Pediatricians were listed as the most common source of information regarding cough medications

 

Implications

 ♥ There is a need to step up education about the

 ineffectiveness of cough  medications.

♥ Pediatricians being the primary source of

 information, should take a leading role in this effort.